The Risk Factors of Symptomatic Communicating Hydrocephalus After Stereotactic Radiosurgery for Unilateral Vestibular Schwannoma: The Implication of Brain Atrophy

• DOI: 10.1016/j.ijrobp.2012.01.048
• Publication Date: 2012-04-10T00:33:00Z
• Authors: Jung Ho Han; Dong Gyu Kim; Hyun-Tai Chung; Sun Ha Paek; Chul-Kee Park; Chae-Yong Kim; Seung-Sik Hwang; Jeong-Hoon Park; Young-Hoon Kim; Jin Wook Kim; Yong Hwy Kim; Sang Woo Song; In Kyung Kim; Hee-Won Jung
• Keywords: Adult; Aged, 80 and over; Male; Time Factors; Adolescent; Brain; Neuroma, Acoustic; Middle Aged; Radiosurgery; Magnetic Resonance Imaging; 03 medical and health sciences; Sex Factors; 0302 clinical medicine; Risk Factors; Confidence Intervals; Humans; Female; Atrophy; Child; Aged; Follow-Up Studies; Hydrocephalus

To identify the effect of brain atrophy on the development of symptomatic communicating hydrocephalus (SCHCP) after stereotactic radiosurgery (SRS) for sporadic unilateral vestibular schwannomas (VS).A total of 444 patients with VS were treated with SRS as a primary treatment. One hundred eighty-one patients (40.8%) were male, and the mean age of the patients was 53±13 years (range, 11-81 years). The mean follow-up duration was 56.8±35.8 months (range, 12-160 months). The mean tumor volume was 2.78±3.33 cm3 (range, 0.03-23.30 cm3). The cross-sectional area of the lateral ventricles (CALV), defined as the combined area of the lateral ventricles at the level of the mammillary body, was measured on coronal T1-weighted magnetic resonance images as an indicator of brain atrophy.At distant follow-up, a total of 25 (5.6%) patients had SCHCP. The median time to symptom development was 7 months (range, 1-48 months). The mean CALV was 334.0±194.0 mm2 (range, 44.70-1170 mm2). The intraclass correlation coefficient was 0.988 (95% confidence interval [CI], 0.976-0.994; p<0.001). In multivariate analysis, the CALV had a significant relationship with the development of SCHCP (p<0.001; odds ration [OR]=1.005; 95% CI, 1.002-1.007). Tumor volume and female sex also had a significant association (p<0.001; OR=1.246; 95% CI, 1.103-1.409; p<0.009; OR=7.256; 95% CI, 1.656-31.797, respectively). However, age failed to show any relationship with the development of SCHCP (p=0.364).Brain atrophy may be related to de novo SCHCP after SRS, especially in female patients with a large VS. Follow-up surveillance should be individualized, considering the risk factors involved for each patient, for prompt diagnosis of SCHCP.